Sick Leave Request Form

Download a blank fillable Sick Leave Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Sick Leave Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Georgia Institute of Technology
VACATION—SICK LEAVE REQUEST FORM
(OHR Policy Section 2.0)
This form must be submitted before taking leave.
Sick Leave Exception:
When accident or illness prevents filing a request before using leave, submit this form immediately upon return to work.
PLEASE TYPE OR PRINT
________________________________
___________________
_______________________________
Name
Employee ID# (PeopleSoft)
Work Unit/Department
I request that I be granted PAID VACATION OR SICK LEAVE as follows:
_____
Vacation Leave
(No documentation required. Simply write in: "Vacation" or "Day Off" in space below.)
_____
Sick Leave
(No documentation is required for the first 5 consecutive days*, unless the manager
requests special documentation.
For routine use, simply write in: "Doctor Appointment" or "Illness" or "Injury" or
"Bereavement" in space below.)
NOTE: *Per Board of Regents Policy, a Doctor's certificate is required for Sick Leave use after 5 consecutive days.
NOTE: Time taken as Sick Leave (or Paid or Unpaid Leave of Absence) may be credited against Family Medical Leave Act eligibility.
Please grant this leave request as a result of the following circumstances. (Provide appropriate & adequate details.)
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Give specific times for each type of leave requested and attach appropriate documentation as noted above.
____________________________________
_______________
_________
____________ _
______
Type of Leave Requested
Beginning Date
and
Time
Ending Date
and
Time
____________________________________
_______________
_________
____________ _
______
Type of Leave Requested
Beginning Date
and
Time
Ending Date
and
Time
Employee Signature ___________________________________
Date __
________________________
_________________________________
___________
[ ] Approved
[ ] Disapproved
Supervisor's Signature
Date
If approval is NOT recommended, attach explanation.
_________________________________
___________
[ ] Approved
[ ] Disapproved
Dean, Department Head, AVP or President
Date
(If Required)
If approval is NOT recommended, attach explanation.
VACATION – SICK LEAVE REQUEST FORM
JUNE 2003

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go